Provider Demographics
NPI:1346014289
Name:ELY CAREFREE LIVING
Entity Type:Organization
Organization Name:ELY CAREFREE LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:MONACELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-741-3013
Mailing Address - Street 1:418 9TH ST S
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2838
Mailing Address - Country:US
Mailing Address - Phone:218-741-3013
Mailing Address - Fax:218-741-1448
Practice Address - Street 1:140 S 2ND AVE W
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:MN
Practice Address - Zip Code:55731-1167
Practice Address - Country:US
Practice Address - Phone:218-365-2261
Practice Address - Fax:218-365-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility